EXHIBIT 15 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655, PREVENTION OF ALCOHOL MISUSE A.pdf
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- Attached to
- CARBON STRIPS
- Solicitation number
- MA141253
- Issued by
- California
About this file
This is a Certificate of Compliance form with the Los Angeles County Metropolitan Transportation Authority (LACMTA) regarding compliance with 49 CFR Part 655 requirements for the prevention of alcohol misuse and prohibited drug use in transit operations. The form requires bidders and proposers to certify their compliance status and establish their eligibility to perform work on LACMTA contracts. Bidders must first determine whether the work required under the contract involves the performance of "Safety Sensitive Functions" as defined in 49 CFR Part 655. If safety-sensitive functions are not required, bidders may proceed directly to the signature section. If safety-sensitive functions are required, bidders must complete additional sections demonstrating their anti-drug and alcohol misuse programs and drug and alcohol testing programs.
For contracts involving safety-sensitive functions, bidders must certify either that they have already established and implemented compliant anti-drug use and alcohol misuse programs and drug and alcohol testing programs, or that they will establish and implement such programs prior to contract award. Bidders selecting the latter option must submit both their anti-drug use and alcohol misuse program and their drug and alcohol testing program to LACMTA for review and approval before contract award. An authorized representative of the bidder must sign the certificate, acknowledging understanding of all requirements and submitting to LACMTA's approval processes.
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Text version
BIDDER/PROPOSER: ______________________
EXHIBIT 15 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655,
PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN
TRANSIT OPERATIONS
Bidder/Proposer hereby certifies that:
A. Safety Sensitive Functions Requirement
(Choose one of the following alternatives by checking the appropriate box)
1.
To the best of my knowledge and belief the Work required under the Contract WILL NOT require the performance of “Safety Sensitive Functions” as defined in 49 CFR Part 655.
OR
2.
To the best of my knowledge and belief the Work required under the Contract WILL require the performance of “Safety Sensitive Functions” as defined in 49 CFR Part 655.
If alternative A.1 was chosen, Bidder/Proposer shall proceed directly to Section D.
If alternative A.2 was chosen, Bidder/Proposer must complete Section B, parts 1 and 2, and Section C, prior to proceeding to Section D.
B. Required Drug and Alcohol Programs
1. Anti-drug Use and Alcohol Misuse Program
(Choose one of the following alternatives by checking the appropriate box)
a. Bidder/Proposer has established and implemented an anti-drug use and alcohol misuse program meeting the requirements on 49 CFR 655.
OR
b.
Bidder/Proposer will establish and implement an anti-drug use and alcohol misuse program meeting the requirements on 49 CFR 655 prior to contract award.
2. Drug and Alcohol Testing Program
(Choose one of the following alternatives by checking the appropriate box)
a. Bidder/Proposer has established and implemented a drug and alcohol testing program that complies with 49 CFR Part 655.
OR
b. Bidder/Proposer will establish and implement a drug and alcohol testing program that will comply with 49 CFR Part 655 prior to contract award.
BIDDER/PROPOSER: ______________________
C. Submittals
If Bidder/Proposer marked Section A.2 above, Bidder/Proposer understands and acknowledges that it must submit (1) its Anti-drug Use and Alcohol Misuse Program and
(2) its Drug and Alcohol Testing Program to LACMTA for review and approval prior to contract award.
Bidder/Proposer Initials ___________
D. Signatures
Bidder/Proposer:
Authorized Representative:
Signature of Authorized Representative:
Title:
Date:
EXHIBIT - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655, PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS
| Authorized Representative: |
| Title: |
| Date: |
| A: |
| 1: Off |
| 2: Off |
| B: |
| 1: |
| a: Off |
| b: Off |
| 2: |
| a: Off |
| b: Off |
| Bidder/Proposer2: |
| BIDDER/PROPOSER: |
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